Shift in AIDS Prevention Strategy;
Emphasis Now on Accountability of Those Infected
San
Francisco Chronicle
Sabin Russell
September 21, 2003
The arrest last week of former San Francisco Health Commissioner Ronald Gene Hill on charges he lied about his HIV-positive status to his sexual partners underscores a growing trend in AIDS prevention: holding those already infected responsible for the health of people with whom they have consensual sex.
While prosecutions are unusual, the stress on the role that positives can play to either check or spread the epidemic is growing. In a controversial move, CDC is recasting its AIDS prevention strategy to focus on rapid testing and identification of HIV-positives, and focusing safer sex education on infected persons.
Recent University of California-San Francisco and RAND studies have found substantial numbers of HIV-positive men and women, gay and straight, engage in sexual activity without disclosing their infections. A nationwide survey of 1,397 HIV-positive men and women found that 13 percent had unprotected anal or vaginal sex without disclosing their infection to partners who were either negative or of unknown status.
UCSF researcher Dr. Daniel Ciccarone, who led the study, said, "A lot of nondisclosure is mutual nondisclosure.... We don't have 13 percent lying about their status; we have a conversation that did not happen," said Ciccarone, who worries that "criminalizing AIDS transmission makes it even more stigmatized, and puts it more underground.
The San Francisco Department of Public Health, with a CDC grant, has been a pioneer in crafting new prevention messages directed at HIV- positives. Since 2002 it has promoted, along with San Francisco AIDS Foundation, advertising campaigns featuring HIV-infected people expressing their concern for the health of their partners, declaring that "HIV stops with me.
"The No. 1 thing men talk about in our program is how to gain the skills to talk about disclosure of HIV status," said Shana Krochmal, spokesperson for Stop AIDS Project in San Francisco.